Tall: Twins Tower is the sequel to Tall Infinity and in this case the game was never released outside Japan. As in Tall Infinity the player manipulate multi-colored blocks to construct a tower. The players needing to complete ten floors of the tower to pass each stage. Players must avoid unnecessary moves or risk losing the game. There are three difficulty levels and different game modes (like endless mode or time attack).

One of the new features is the slide mode in which using the R1 and L1 Button the player can move a whole line of blocks to the right or to the left, the game also features a 2 players split screen vs mode.